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My irritated skin is affecting my sex life. What can I do?

The question: I am a 25-year-old woman and have been experiencing irritation on my labia. I've seen my doctor and there isn't an infection. I've tried everything from tea tree oil, non-scented cleansers and a number of herbal options, but no change. Despite my best efforts, I feel that everything I use is making it worse, I'm uncomfortable and it's difficult for me to think about being intimate. Can you help me?

The answer: Skin irritation in general can be uncomfortable, but when it occurs on our most sensitive parts such as the vagina or labia, it can be very unpleasant. Often when I see people for this concern, it is after several weeks or months of vigilant self-treatment with a variety of oils and creams. Like you, many of my patients continue to struggle with the discomfort and they also note the negative impact it has had on their intimacy.

The external part of the genitals is known as the vulva or labia and is made up of sensitive skin, hair and glands. Secretions from the glands and the vagina keep the area healthy, protected and moist.

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It's good that you've first ruled out potential infectious causes such as bacterial vaginosis, yeast and sexually transmitted infections.

While we often think of infection as the main cause of irritation, the most common culprits are what we put on our labia and vagina, and our day-to-day activities that can cause friction in the area including biking and wearing tight clothing. Take a quick inventory of what could be in your environment that may be causing irritation, such as detergents, soaps and lubrication. Even though it sounds like you use natural products, these can also irritate already sensitive skin.

To help you through this, I consulted my colleague, Dr. Deborah Robertson, a staff gynecologist at St. Michael's Hospital with a specialization in vulvar health.

Dr. Robertson noted that a common reaction when we have irritation is to vigorously wash the area to "disinfect" it. She says patients"shouldn't use anything but water on the vulva. No soaps, no creams, no douches, just water."

She also explained why we put a strong focus on cleaning the vagina and why so many products have been developed for vulvar hygiene. Apparently, our common home cleanser Lysol was first created to use as a vaginal cleanser. Of course, we now know to not use this but it does emphasize the pressure women have had to keep their vaginas sterile. Dr. Robertson notes that "the vagina is like a self-cleaning oven," so all it needs is some of water. She also reassures patients that "a little bit of white or clear discharge is normal."

The bottom line: Give your vulva and vagina an opportunity to do its natural self-cleaning and avoid using anything in the area apart from water. If the issue persists despite making these changes, visit your doctor or gynecologist to ensure there isn't anything else that could be causing the irritation. An excellent resource on how to care for your labia can also be found here.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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